Provider Demographics
NPI:1801181417
Name:IRWIN, CATHERINE DIANE (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:DIANE
Last Name:IRWIN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2735 SUNRUNNER LN
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-5510
Mailing Address - Country:US
Mailing Address - Phone:850-934-5857
Mailing Address - Fax:859-916-6590
Practice Address - Street 1:2735 SUNRUNNER LN
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-5510
Practice Address - Country:US
Practice Address - Phone:850-934-5857
Practice Address - Fax:859-916-6590
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-03-1049103K00000X
FL1031049103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL679778496Medicaid
FL679778498Medicaid